Why Did He Die? the Attributions of Cause of Death among Women Widowed in Later Life

The study aimed to examine the causal attributions of death made spontaneously by older widowed women to explain the deaths of their husbands. The data presented are from two qualitative interview studies using the same methodology. There were 65 widows aged between 55 and 93 years old who had been widowed between 0.25 and 60 years. Data were analysed using a grounded theory method and content analysis. Nearly half of the women gave causal explanations for why their husbands died. These explanations can be best understood in terms of lay illness attributions. These results indicate that a broad analysis of cause of death attributions is important in understanding the bereavement experience. The function of attributions in post-bereavement experiences is also examined.

The Bereavement Guilt Scale

The rationale, development, and validation of the Bereavement Guilt Scale (BGS) are described in this article. The BGS was based on a theoretically developed, multidimensional conceptualization of guilt. Part 1 describes the generation of the item pool, derived from in-depth interviews, and review of the scientific literature. Part 2 details statistical analyses for further item selection (Sample 1, N = 273). Part 3 covers the psychometric properties of the emergent-BGS (Sample 2, N = 600, and Sample 3, N = 479). Confirmatory factor analysis indicated that a five-factor model fit the data best. Correlations of BGS scores with depression, anxiety, self-esteem, self-forgiveness, and mode of death were consistent with theoretical predictions, supporting the construct validity of the measure. The internal consistency and test–retest reliability were also supported. Thus, initial testing or examination suggests that the BGS is a valid tool to assess multiple components of bereavement guilt. Further psychometric testing across cultures is recommended.

Unfinished Business in Bereavement

Unfinished business (incomplete, unexpressed or unresolved relationship issues with the deceased) is frequently discussed as a risk factor for chronic and severe grief reactions. However, few empirical studies have examined this construct. The present study aimed to address this gap in the literature by examining the presence and severity of unfinished business as well as common themes of unfinished business reported in open-ended qualitative narratives among a sample of 224 bereaved individuals. In bivariate analyses, self-reported presence of unfinished business and the severity of distress due to unfinished business were both found to be associated with poorer bereavement outcomes. However, after controlling for potential confounds, distress related to unresolved issues with the deceased emerged as a more robust correlate of these outcomes. Qualitative responses were categorized, and the type of reported unfinished business was not significantly related to the degree of unfinished business distress or other bereavement outcomes. These findings provide preliminary justification for bereavement interventions that aim to ameliorate distress related to unresolved relational issues with the deceased.

Let me hear of your mercy in the mourning: forgiveness, grief, and continuing bonds

Clarity about the utility of continuing bonds (CB) continues to be evasive in the research. In 2 different correlational studies, the authors explored the relationship between CB and 2 other variables: 1 representing mental health (forgiveness of the deceased) and the other representing psychological distress (prolonged grief). Although researchers have addressed the latter relationship in the literature, assessing the relationship between CB and forgiveness has not been undertaken. Results suggest that forgiveness in general, and affective aspects of forgiveness in particular, predict psychological forms of CB. Results related to grief depended on how CB was assessed. These findings provide evidence of the relative health of certain types of relationship with deceased persons and also suggest that forgiveness interventions may be a way of promoting such healthy bonds.

Guilt in bereavement: the role of self-blame and regret in coping with loss

Despite the apparent centrality of guilt in complicating reactions following bereavement, scientific investigation has been limited. Establishing the impact of specific components associated with guilt could enhance understanding. The aim of this study was to examine the relationships between two guilt-related manifestations, namely self-blame and regret, with grief and depression. A longitudinal investigation was conducted 4–7 months, 14 months and 2 years post-loss. Participants were bereaved spouses (30 widows; 30 widowers); their mean age was 53.05 years. Results showed that self-blame was associated with grief at the initial time-point and with its decline over time. Such associations were not found for depression. Initial levels of regret were neither associated with initial levels of grief and depression, nor were they related to the decline over time in either outcome variable. These results demonstrate the importance of examining guilt-related manifestations independently, over time, and with respect to both generic and grief-specific outcome variables. A main conclusion is that self-blame (but not regret) is a powerful determinant of grief-specific difficulties following the loss of a loved one. Implications for intervention are considered.

Guilt in bereavement: a review and conceptual framework

Thirty-four quantitative and 9 qualitative studies are reviewed to indicate current understanding of the nature and impact of guilt in bereavement. This overview suggests that guilt is especially prevalent among some vulnerable subgroups, and it is associated with maladaptive health outcomes. Being male, longer bereavement time, and good end-of life experience seem to be associated with less guilt feelings. However, definition ambiguity, measurement difficulties, and cultural insensitivity are evident in studies. Therefore, a multidimensional conceptualization of guilt and a structural model to guide future investigation of this phenomenon in the bereavement context is proposed.

Commentary on the inclusion of persistent complex bereavement-related disorder in DSM-5

The DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group has proposed criteria for Persistent Complex Bereavement-Related Disorder (PCBRD) for inclusion in the appendix of DSM-5. The authors feel that it is important that dysfunctional grief will become a formal condition in DSM-5 because that would facilitate research and would imply recognition of the suffering of a significant minority of bereaved individuals who experience difficulties in their process of recovery from loss. However, as detailed in this commentary, we oppose the inclusion of the proposed criteria set for PCBRD for several reasons, including the fact that these criteria lack empirical evidence. In our view, it is better to include empirically validated criteria for prolonged grief disorder in DSM-5, possibly expanded with a few symptom criteria that are tapped by the Inventory of Complicated Grief the most widely used instrument to measure dysfunctional grief.

Continuing bonds and adjustment at 5 years after the death of a spouse

Thirty-nine bereaved individuals completed the Continuing Bonds Scale (CBS), assessing various aspects of the ongoing attachment to the deceased, at 60 months postloss in a longitudinal conjugal bereavement study. They also completed symptom measures at 6, 14, 25, and 60 months postloss. Higher CBS scores were associated with a more elevated grief-specific symptom pattern over the 5-year postloss period. Moreover, those who expressed greater helplessness and less blame toward the deceased during a monologue role-play involving their deceased spouse at 6 months postloss had higher CBS scores. Finally, greater satisfaction in the past relationship with the spouse was predictive of higher CBS scores. The results were discussed in relation to existing literature on the adaptiveness of continuing bonds.

The varieties of grief experience

The bereavement literature has yet to show consensus on a clear definition of normal and abnormal or complicated grief reactions. According to DSM-IV, bereavement is a stressor event that warrants a clinical diagnosis only in extreme cases when other DSM categories of psychopathology (e.g., Major Depression) are evident. In contrast, bereavement theorists have proposed a number of different types of abnormal grief reactions, including those in which grief is masked or delayed. In this article, we review empirical evidence on the longitudinal course, phenomenological features, and possible diagnostic relevance of grief reactions. This evidence was generally consistent with the DSM-IV's view of bereavement and provided little support for more complicated taxonomies. Most bereaved individuals showed moderate disruptions in functioning during the first year after a loss, while more chronic symptoms were evidenced by a relatively small minority. Further, those individuals showing chronic grief reactions can be relatively easily accommodated by existing diagnostic categories. Finally, we found no evidence to support the proposed delayed grief category. We close by suggesting directions for subsequent research.